(a) The following terms are defined:(1) '911 call' means a communication indicating that an individual may need emergency medical services; (2) 'Alternative destination' means a lower-acuity facility that provides medical services, including without limitation:(A) A federally-qualified health center;(B) An urgent care center;(C) A rural health clinic;(D) A physician office or medical clinic as selected by the patient; and(E) A behavioral or mental health care facility including, without limitation, a crisis stabilization unit.'Alternative destination' does not include a:(A) Critical access hospital;(B) Dialysis center;(C) Hospital;(D) Private residence; or(E) Skilled nursing facility;(3) 'Emergency medical services agency' means any agency licensed under 16-4C-6a of this code to provide emergency medical services: Provided, That rotary and fixed wing air ambulances are specifically excluded from the definition of an emergency medical services agency;(4) 'Medical command' means the issuing of orders by a physician from a medical facility to emergency medical services personnel for the purpose of providing appropriate patient care; and(5) 'Telehealth services' means the use of e issuing of orders by a physician from a medical facility to emergency medical services personnel for the purpose of providing appropriate patient care; and(5) 'Telehealth services' means the use of synchronous or asynchronous telecommunications technology or audio-only telephone calls by a health care practitioner to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include e-mail messages or facsimile transmissions.(b) An insurer which issues or renews a health insurance policy on or after January 1, 2025, shall provide coverage for:(1) An emergency medical services agency to:(A) Treat an enrollee in place if the ambulance service is coordinating the care of the enrollee through telehealth services with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; (B) Triage or triage and transport an enrollee to an alternative destination if the ambulance service is coordinating the care of the a behavioral health specialist for a behavioral-based complaint; (B) Triage or triage and transport an enrollee to an alternative destination if the ambulance service is coordinating the care of the enrollee through telehealth services with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or(C) An encounter between an ambulance service and enrollee that results in no transport of the enrollee if:(i) The enrollee declines to be transported against medical advice; and(ii) The emergency medical services agency is coordinating the care of the enrollee through telehealth services or medical command with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.(c) The coverage under this section:(1) Only includes emergency medical services transportation to the treatment location;(2) Is subject to the initiation of response, triage, and treatment as a result of a 911 call that is documented in the records of the emergency medical services agency;(3) Is subject to deductibles or copayment requirements of the policy, contract, or plan;(4) Does not diminish or limit call that is documented in the records of the emergency medical services agency;(3) Is subject to deductibles or copayment requirements of the policy, contract, or plan;(4) Does not diminish or limit benefits otherwise allowable under a health benefit plan, even if the billing claims for medical or behavioral health services overlap in time that is billed by the ambulance service also providing care; and (5) Does not include rotary or fixed wing air ambulance services. (d) The reimbursement rate for an emergency medical services agency that triages, treats, and transports a patient to an alternative destination, or triages, treats, and does not transport a patient, if the patient declines to be transported against medical advice, if the ambulance service is coordinating the care of the enrollee through medical command or telemedicine with a physician for a medical-based complaint, or with a behavioral health specialist for a behavioral-based complaint under this section, shall be reimbursed at the same rate as if the patient were transported to an emergency room of a facility provider.
West Virginia Legal Code